Bottom Line:
The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors.The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature.Their execution requires an interdisciplinary team approach.

Affiliation: Department of Otolaryngology, Head & Neck Surgery, University Medicine of Regensburg, Germany.

ABSTRACTMinimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach.

Mentions:
In the study cited in 9.2.4, Andaluz et al. report the treatment 5 non-ruptured aneurysms of the anterior circulation after resection of a large superolateral bone segment via an upper eyelid approach. The average diameter of the aneurysm was 5 mm. The median duration of hospitalization was 2.2 days. Complications were not observed. The bone segment was repositioned by means of plate osteosynthesis. The cosmetic outcome was excellent 3 months after surgery [28]. Abdel Aziz et al. reported in a study of 40 patients about 31/40 patients who underwent treatment for aneurysm of the anterior circulation [24]. Abdel Aziz observed 4 complications, 1 hematoma of the eyelid, 2 infections, and 1 CSF leak. All complications were reversible. As discussed above, the studies of Andaluz and especially of Abdel Aziz do not meet the inclusion criteria of the present analysis, because the incision is drawn laterally beyond the bony orbital rim. However, to complement the topic, they are mentioned here as they excellently illustrate the enormous potential of the transorbital accesses. The authors of the present paper have released the lateral canthal ligament through a lateral extension of the supra-supratarsal incision for access to the lateral orbital wall and anterolateral skull base. By this access and after temporary resection of a bone segment, the retroorbital lesion (Figure 16 (Fig. 16)) of a 66-year-old patient with progressive exophthalmos and diplopia was completely extirpated (Figure 17 (Fig. 17)). There was no need for ICU admission, he was ambulatory the day of surgery, and diplopia and exophthalmos were completely resolved.

Mentions:
In the study cited in 9.2.4, Andaluz et al. report the treatment 5 non-ruptured aneurysms of the anterior circulation after resection of a large superolateral bone segment via an upper eyelid approach. The average diameter of the aneurysm was 5 mm. The median duration of hospitalization was 2.2 days. Complications were not observed. The bone segment was repositioned by means of plate osteosynthesis. The cosmetic outcome was excellent 3 months after surgery [28]. Abdel Aziz et al. reported in a study of 40 patients about 31/40 patients who underwent treatment for aneurysm of the anterior circulation [24]. Abdel Aziz observed 4 complications, 1 hematoma of the eyelid, 2 infections, and 1 CSF leak. All complications were reversible. As discussed above, the studies of Andaluz and especially of Abdel Aziz do not meet the inclusion criteria of the present analysis, because the incision is drawn laterally beyond the bony orbital rim. However, to complement the topic, they are mentioned here as they excellently illustrate the enormous potential of the transorbital accesses. The authors of the present paper have released the lateral canthal ligament through a lateral extension of the supra-supratarsal incision for access to the lateral orbital wall and anterolateral skull base. By this access and after temporary resection of a bone segment, the retroorbital lesion (Figure 16 (Fig. 16)) of a 66-year-old patient with progressive exophthalmos and diplopia was completely extirpated (Figure 17 (Fig. 17)). There was no need for ICU admission, he was ambulatory the day of surgery, and diplopia and exophthalmos were completely resolved.

Bottom Line:
The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors.The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature.Their execution requires an interdisciplinary team approach.

Affiliation:
Department of Otolaryngology, Head & Neck Surgery, University Medicine of Regensburg, Germany.

ABSTRACTMinimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach.